Nursing Elites

1. Quality is defined as a combination of all of the following except:

• A. conforming to standards.
• B. performing at the minimally acceptable level.
• C. meeting or exceeding customer requirements.
• D. exceeding customer expectations.

Correct answer: B

Rationale: The correct answer is 'performing at the minimally acceptable level.' Quality is about meeting or exceeding customer requirements and expectations, as well as conforming to standards. The term 'performing at the minimally acceptable level' implies just meeting the minimum requirements, which falls short of the comprehensive definition of quality in terms of customer satisfaction and excellence. Therefore, this choice is the exception when defining quality. Choices A, C, and D align with the definition of quality as they all involve meeting or surpassing certain criteria for customer satisfaction and product excellence, which are essential components of quality management.

2. The home health nurse has made a visit to an 85-year-old female client's home who has recently had surgery to replace her left knee. The client has been discharged from a rehab facility and has been able to walk on her own. The nurse assesses the need for teaching related to fall prevention. What should the nurse include in this teaching plan?

• A. The client should remove all scatter rugs from the floor and minimize clutter.
• B. The client should not limit her movement within the home unless advised by the physician.
• C. The client should have a raised toilet seat and grab bars available in the bathroom.
• D. The client should not wear a robe and socks while walking in the house.

Correct answer: A

Rationale: The correct answer is to instruct the client to remove all scatter rugs from the floor and minimize clutter. Rugs and clutter are common causes of falls in the home, especially for the elderly or those with gait issues. Removing them can significantly reduce the risk of falls. While having a raised toilet seat and grab bars in the bathroom is important for safety, it is not the priority in this scenario. The client should not limit her movement within the home unless specifically advised by the physician, as maintaining mobility is essential for recovery. Lastly, the client should avoid wearing robes and socks while walking in the house to prevent tripping, slipping, or falling on slippery floors.

3. A client with dumping syndrome should..........................while a client with GERD should..........................

• A. Sit up 1 hour after meals; lie flat 30 minutes after meals
• B. Lie down 1 hour after eating; sit up at least 30 minutes after eating
• C. Sit up after meals; sit up after meals
• D. Lie down after meals; lie down after meals

Correct answer: D

Rationale: For a client with dumping syndrome, lying down 1 hour after eating helps reduce symptoms by slowing down the movement of food through the digestive tract, aiding in symptom management. This position assists in symptom management for dumping syndrome. Conversely, for a client with GERD, sitting up at least 30 minutes after eating can help prevent the backflow of stomach acid into the esophagus, reducing reflux symptoms. This upright position is beneficial for managing GERD. Choice A is incorrect because sitting up is recommended for GERD, not dumping syndrome. Choice C is incorrect as it suggests sitting up for both conditions, which is not appropriate. Choice D is incorrect as lying down after meals is not recommended for GERD; it can worsen symptoms by promoting acid reflux.

4. When evaluating a kinetic family drawing, which of the following actions is most effective?

• A. asking the child to draw their family doing something
• B. offering specific suggestions of what to include in the drawing
• C. discouraging the child from talking about the drawing
• D. noting the omission of any family members

Correct answer: D

Rationale: When evaluating a kinetic family drawing, noting the omission of any family members is an effective action. It is crucial to observe and analyze all aspects of the drawing, including what is missing. This can provide valuable insights into the child's perception and relationships within the family. Asking the child to draw their family doing something (Choice A) is more related to initial instruction rather than evaluation. Offering specific suggestions (Choice B) can influence the child's drawing and should be avoided to maintain the authenticity of the representation. Discouraging the child from talking about the drawing (Choice C) is counterproductive as verbal expression can provide additional context and understanding.

5. Which of the following strategies should the nurse include when planning care for children of migrant workers?

• A. Delay immunizations due to acute illness.
• B. Provide parents with copies of medical records.
• C. Offer preventive services during acute illness visits.
• D. Emphasize the importance of having one primary care provider.

Correct answer: B

Rationale: When planning care for children of migrant workers, providing parents with copies of medical records is essential. This helps ensure continuity of care, especially as migrant families may move frequently. Immunizations should not be delayed due to acute illness; preventive care, including immunizations, should be provided even during acute illness visits to ensure the child stays up to date. While it is important to offer preventive services during routine visits, it is not ideal to provide them only during acute illness visits. Emphasizing the importance of having one primary care provider is valuable in healthcare, but it may not be feasible for migrant families due to their mobility.

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